Biologic therapy (also called immunotherapy) uses drugs to improve the way your body fights cancer. The therapy attempts to repair, stimulate, or enhance the immune system so that it can identify and fight the cancer cells more effectively. It may be used alone or in combination with other treatments.

Cytokines are reproduced proteins that activate the body's immune system. Examples of cytokines used to treat kidney cancer include interferon alfa and interleukin 2 ( IL-2, aldesleukin, or proleukin).

Interleukin 2 (IL-2) is given by injection under the skin or by IV for metastatic kidney cancer. Treatment may be given in cycles separated by a rest period. In some cases, IL-2 results in shrinking the tumor. In others, the tumor may disappear completely, though there is a chance of recurrence. IL-2 treatment is not appropriate for all people with metastatic kidney cancer because of the serious side effects.

Common Side Effects

IL-2:

Chills
Fever
Low blood pressure
Kidney damage
Diarrhea
Gastrointestinal bleeding
Heart attack
Shortness of breath from the build-up of fluid in the lungs
Rapid heartbeat

Targeted Therapy

Targeted therapies attempt to interfere with the growth of the tumor by blocking the formation of new blood vessels around the tumor. Though not a cure, these medications may shrink or slow the growth and/or spread of tumors and extend survival time.

Bevacizumab

Bevacizumab works by slowing the growth of new blood vessels. At times it may be combined with interferon alfa, which boosts specific components of the immune system.

The most common side effects when bevacizumab is used alone include:

High blood pressure
Bleeding
Intestinal perforation or fistula (an abnormal opening between 2 bodily structures)
Blisters on the palms of the hands or soles of the feet
Diarrhea
Constipation
Loss of appetite
Fatigue
Weakness
Altered taste
Mouth irritation
Protein in the urine
Difficulty breathing

The most common side effects when bevacizumab is used in combination with interferon alfa include:

Fatigue
Weakness
Protein in the urine
High blood pressure
Gastrointestinal bleeding or perforation

Axitinib

Axitinib works by preventing the growth of new blood vessels to tumors through various pathways. The most common side effects include:

Diarrhea
High blood pressure
Loss of appetite
Nausea or vomiting
Constipation
Blisters on the palms of the hands or soles of the feet
Weakness
Difficulty speaking

Everolimus

Everolimus reduces the blood supply and slows tumor growth. It may be used when other, similar types medications are no longer working. The most common side effects include:

High blood pressure
Rash
Constipation
Mouth irritation
Anemia
Slower wound healing
Fatigue
Weakness
Menstrual problems
Cough
Difficulty breathing

Pazopanib

Pazopanib works by preventing the growth of new blood vessels to tumors. The most common side effects include:

Diarrhea
High blood pressure
Hair color changes
Nausea or vomiting
Loss of appetite

Sorafenib

Sorafenib targets several different pathways of tumor growth. The most common side effects include:

Rash
Diarrhea
High blood pressure
Redness
Pain
Swelling
Blisters on the palms of the hands or soles of the feet
Nerve damage

Sunitinib

Sunitinib attacks both blood vessel growth and other targets that stimulate cancer cell growth. The results show tumor shrinkage in one third of the patients treated. Side effects may include:

Diarrhea
Change in skin color
Mouth irritation
Weakness
Altered taste
Fatigue
High blood pressure
Bleeding
Hypothyroidism

Temsirolimus

Temsirolimus works to inhibit cell growth. The most common side effects include:

Skin rash
Feeling weak
Mouth irritation
Nausea
Loss of appetite
Fluid buildup in the face or legs
Increases in blood sugar and cholesterol levels

Dialysis

If both kidneys are removed or no longer function, dialysis will be necessary. Dialysis mimics kidney function by filtering wastes and excess fluids from the blood. It is a permanent treatment if a kidney transplant cannot be done. There are 2 main types of dialysis:

Hemodialysis —Blood is pumped from a vein into a machine (called a dialyzer) outside of the body. The machine filters the blood and returns it to the body. Treatment is typically done 3 times per week for up to 4 hours. Treatment times and frequency can vary from person to person.
Peritoneal—A sterile solution enters the abdominal cavity through a tube. The abdominal cavity is lined with blood vessels. The blood vessels and solution interact to draw wastes and excess fluids into the solution. The solution is then drained from the abdominal cavity. Peritoneal dialysis can be done at home, often during the night, eliminating the need to travel to a hemodialysis facility for treatment.

References:

Kidney cancer treatment. American Cancer Society website. Available at: https://www.cancer.org/cancer/kidney-cancer/treating.html. Accessed February 28, 2020.

Kidney cancer: treatment. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kc-treatment. Accessed February 28, 2020.

Renal cell carcinoma. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated October 10, 2018. Accessed February 28, 2020.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/kidney/patient/kidney-treatment-pdq#section/_93. Updated May 22, 2019. Accessed February 28, 2020.

Last reviewed December 2019 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 2/28/2020

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